Background: The purpose of universal health coverage (UHC) is to provide equitable access to health services to people without financial hardship. Nevertheless, despite the diverse measures in place to accomplish this goal, there are still obstacles including access to affordable essential medicines. Specifically, low and middle-income regions like Sub-Saharan Africa and South Asian countries are the most affected due to regional disparities in achieving UHC. Citizens in financially vulnerable positions in these nations rely on their governments to provide essential medicines at little or no cost. However, government health systems are plagued with the unavailability of necessary medicines and services, forcing citizens to resort to more expensive private options and placing them at greater financial risk. The pharmaceutical ecosystem is responsible for the research, development, manufacturing, distribution, regulation, and safe use of these medicines. This study reviewed the impact of the pharmaceutical ecosystem in achieving universal health coverage in Sub-Saharan Africa. Method: A narrative review of published peer-reviewed articles and grey literature was executed to examine how the pharmaceutical ecosystems have impacted universal access to the use of medicines thus achieving universal health coverage. Conclusion: The pharmaceutical ecosystem sector is complex and crucial in achieving Universal Health Coverage as it directly affects the accessibility of safe, effective, and affordable essential medicines. Pharmacists are the major drivers of this ecosystem and should build their capacity in this area for positive results to be achieved in improving access to medicines and reducing the global disease burden. In Sub-Saharan Africa, due to the lack of government structures and enforcement, sectors of this ecosystem operate sub-optimally, and players and actors have taken advantage of its weaknesses and disorganization. Therefore, further research is imperative to identify ways to progress and improve the pharmaceutical ecosystem.